Clinical Nutritionist CCN Clinical Nutritionist CCN MCQ 4 — Questions and Answers
Question 1: A 45-year-old client has elevated serum ferritin (600 ng/mL), elevated transferrin saturation (55%), and fatigue. Which condition should the clinical nutritionist suspect and refer for?
- Iron deficiency anemia
- Hereditary hemochromatosis (Correct answer)
- Anemia of chronic disease
- Thalassemia minor
Correct answer: Hereditary hemochromatosis
Elevated ferritin combined with high transferrin saturation is the hallmark presentation of hereditary hemochromatosis, a condition requiring medical management and dietary iron reduction.
Question 2: Which dietary approach has the most evidence for reducing blood pressure in hypertensive adults, beyond sodium restriction alone?
- Ketogenic diet
- DASH (Dietary Approaches to Stop Hypertension) diet (Correct answer)
- Paleo diet
- Low-fat vegan diet
Correct answer: DASH (Dietary Approaches to Stop Hypertension) diet
The DASH diet, rich in potassium, magnesium, calcium, and fiber while low in saturated fat and sodium, has robust RCT evidence for clinically significant blood pressure reduction.
Question 3: A patient with celiac disease continues to have gastrointestinal symptoms despite following a gluten-free diet. What is the most likely nutritional concern to investigate first?
- Vitamin D toxicity from supplements
- Secondary lactose intolerance due to villous atrophy (Correct answer)
- Excess fiber causing malabsorption
- Iron overload from fortified GF foods
Correct answer: Secondary lactose intolerance due to villous atrophy
Villous atrophy from celiac disease reduces lactase production; secondary lactose intolerance is common in celiac patients and persists until the gut heals.
Question 4: Which lipoprotein is considered the primary carrier of cholesterol from the liver to peripheral tissues?
- High-density lipoprotein (HDL)
- Very-low-density lipoprotein (VLDL)
- Low-density lipoprotein (LDL) (Correct answer)
- Chylomicron
Correct answer: Low-density lipoprotein (LDL)
LDL is the end product of VLDL catabolism and is the primary carrier delivering cholesterol to peripheral cells via the LDL receptor pathway.
Question 5: A post-bariatric surgery patient (Roux-en-Y gastric bypass) is at highest risk for deficiency of which nutrient due to bypass of the duodenum?
- Vitamin C
- Calcium and iron (Correct answer)
- Vitamin K
- Vitamin B1 (thiamine)
Correct answer: Calcium and iron
The duodenum is the primary site for calcium and non-heme iron absorption; bypassing it dramatically increases risk of deficiency for both nutrients in RYGB patients.
Question 6: Which mechanism explains why excessive alcohol intake leads to hypoglycemia in a fasted individual?
- Alcohol stimulates insulin secretion
- Alcohol inhibits hepatic gluconeogenesis by increasing the NADH:NAD+ ratio (Correct answer)
- Alcohol accelerates glycogen breakdown
- Alcohol blocks glucagon release from the pancreas
Correct answer: Alcohol inhibits hepatic gluconeogenesis by increasing the NADH:NAD+ ratio
Ethanol metabolism generates excess NADH, shifting the liver away from gluconeogenesis toward lactate and fat metabolism, causing hypoglycemia when glycogen stores are depleted.
Question 7: When counseling a client about the role of zinc, which physiological function is most directly dependent on adequate zinc status?
- Oxygen transport in red blood cells
- Immune function and wound healing (Correct answer)
- Calcium absorption in the small intestine
- Synthesis of thyroid hormones
Correct answer: Immune function and wound healing
Zinc is essential for T-cell maturation, immune cell signaling, and collagen synthesis in wound healing, making immune function and wound repair primary clinical indicators of zinc status.
Clinical Nutritionist CCN Clinical Nutritionist CCN MCQ 4
A 45-year-old client has elevated serum ferritin (600 ng/mL), elevated transferrin saturation (55%), and fatigue.
Which condition should the clinical nutritionist suspect and refer for?